51±¾É«

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The Safeguards Rule requires covered financial institutions to report to the 51±¾É«security events affecting 500 or more people. Your report may be made public. If law enforcement has requested a delay in making this report public, please check the appropriate box below.

OMB APPROVAL NO.: 3084-0171 
EXPIRATION DATE: 12/31/2026

The Safeguards Rule requires covered financial institutions to report to the 51±¾É«security events affecting 500 or more people. Your report may be made public. If law enforcement has requested a delay in making this report public, please check the appropriate box below.  You should receive a reply email within two business days with instructions for the secure electronic submission of encrypted documents. 

 

Contact Person at Affected Financial Institution

Delayed Publishing

Your report may be made public. If law enforcement has requested a delay in making this report public, please check the appropriate box below.

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 3084-0171. The estimated average time to read the instructions, gather the information, and complete this form is 5 hours. If you have any comments regarding the burden estimate you can write to 51±¾É«; Assoc. Director - GLB; DPIP; 600 Pennsylvania Ave. N.W.; Mail Stop CC-8232; Washington, D.C. 20580. 

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